Thyroid Research最新文献

Background: Patients with thyroid eye disease may develop dysthyroid optic neuropathy (DON), which is commonly treated via orbital decompression surgery. This study aims to identify preoperative factors that can predict postoperative best corrected visual acuity (BCVA) in patients with DON and to classify recovery rates based on these prognostic factors.

Methods: We retrospectively assessed thirty-two patients (51 orbits) diagnosed with DON who underwent orbital decompression.

Results: Univariate and multivariate mixed effects analysis revealed that preoperative BCVA was the strongest predictor of postoperative BCVA (p < 0.0001). Other significant prognostic factors were extraocular muscle hypertrophy (p = 0.01), visual field mean deviation (p = 0.009), retinal nerve fiber layer thickness (p = 0.01), and afferent pupillary defect (p < 0.0001). We then stratified outcomes by the strongest prognostic factor, preoperative BCVA, which demonstrated that 17 of 19 (89.5%) orbits with preoperative BCVA < logMAR 0.20 (20/32 Snellen) achieved acceptable final vision (defined as better than logMAR 0.40 or 20/50 Snellen), compared to 16 of 20 (80%) orbits with preoperative BCVA logMAR 0.20-0.60 (20/32-20/80 Snellen), and only 3 of 11 (27.3%) orbits with preoperative BCVA > logMAR 0.60 (20/80 Snellen). Patients with preoperative BCVA of logMAR 0.60 (20/80 Snellen) or better had > 80% chance of recovering with acceptable final vision after surgery, compared to a < 30% chance for patients with preoperative BCVA worse than logMAR 0.60 (20/80 Snellen).

Conclusions: These results highlight preoperative BCVA as the strongest predictor of DON outcome and suggest that earlier intervention prior to substantial BCVA deterioration may yield better results.

Level of evidence: 3: Retrospectively Registered.

Background: Struma ovarii (SO) is a specialized monodermal teratoma composed predominantly of thyroid tissue (≥ 50%) and accounts for approximately 5% of all ovarian teratomas. In rare cases, the benign SO may spread to the peritoneal cavity and exhibit the histological features of struma ovarii in a condition termed peritoneal strumosis. Here, we present a rare case of complete remission of peritoneal strumosis from SO after radioiodine therapy.

Case presentation: A 41-year-old Chinese woman underwent transabdominal left oophorectomy for a benign SO 18 years prior to presentation in the clinic. She was admitted to our institution for periodic medical examination after ultrasonography revealed a left pelvic mass. The patient underwent total abdominal hysterectomy, right salpingo-oophorectomy, and omentectomy, and multiple biopsies were taken from the omentum and mesentery. Pathology revealed peritoneal strumosis without evidence of malignancy from SO. Afterward, a total thyroidectomy was performed, and a histological examination revealed multinodular goiter. In total, 4400 MBq of 131I was administered, and lesion remission was confirmed. Finally, after 1 year of follow-up, the patient had no evidence of recurrence.

Conclusion: Peritoneal strumosis from OS is a rare aggressive clinical manifestation that differs from malignancy. Conservative surgery with personalized radioiodine may be a practical therapeutic option for unresectable peritoneal strumosis, and long-term monitoring is recommended.

Background: Subclinical hypothyroidism (SCH) during pregnancy affects a significant proportion of women, yet its impact on maternal well-being remains insufficiently explored. Current diagnostic and treatment guidelines focus primarily on thyroid-stimulating hormone (TSH) levels, often overlooking the broader implications of SCH on maternal quality of life (QoL). This narrow focus may lead to missed opportunities for interventions that could enhance the overall well-being of this population. In this study, we aimed to assess the impact of SCH on QoL in first-trimester pregnant women and determine whether untreated SCH with TSH levels between 2.5 and 4 µIU/mL compromises maternal well-being.

Materials and methods: This is a cross-sectional study conducted on pregnant women during first trimester of pregnancy. Participants were divided into SCH and euthyroid groups based on TSH levels. Data regarding health-related quality of life (HRQoL) was collected using a questionnaire previously described and validated for study population. Data were analysed using descriptive statistics, comparative tests, and multiple linear regression.

Results: Among 409 pregnant women, those with SCH demonstrated notably lower physical and mental HRQoL compared to those with normal thyroid function. The physical component score was 14.59 ± 3.63 in the SCH group versus 15.96 ± 3.44 in the euthyroid group (p < 0.001), while the mental component score was 20.24 ± 4.24 in the SCH group compared to 22.39 ± 4.55 in the euthyroid group (p < 0.001). This decline affected all areas assessed, including general and mental health, physical function, bodily pain, and social functioning. TSH levels emerged as a significant predictor of overall HRQoL using regression analysis (B coefficient - 1.30,95% CI: -2.08 to -0.52; p = 0.001).

Conclusion: This study demonstrates that SCH significantly compromises the HRQoL in pregnant women. The findings underscore the necessity for comprehensive management strategies that not only prioritize the optimization of thyroid function but also address the significant QoL impairments observed in SCH. Given the current lack of treatment recommendations for SCH in pregnant women based on TSH alone, QoL should be incorporated into clinical guidelines to provide more patient-centered care.

Background: Tyrosine kinase inhibitors (TKIs) have significantly improved the prognosis of patients with advanced medullary thyroid cancer (MTC). However, treatment response heterogeneity leads to challenges in predicting individual favourable response. This study evaluated the correlation between PET metrics on ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CTs prior to treatment, and TKI response.

Methods: This study retrospectively evaluated patients with metastatic MTC who received TKIs at a tertiary care hospital and had prior ⁶⁸Ga-DOTATATE and/or ¹⁸F-FDG PET/CT imaging. Patient demographics, treatment and PET/CT data were collected. Standardized Uptake Value (SUV) max, SUVmean, Total Lesion Activity (TLA) and Metabolic Tumor Volume (MTV) were determined per PET/CT.

Results: In the 25 patients, mean age at diagnosis was 48 (±15) years; 11 (44%) were female and 21 tumors harbored RET driver alterations. Thirty-six TKI treatments were administered (11 patients received two TKIs sequentially). RECIST response rates (available in 32/36 treatments) included; stable disease in 8/32 (25%), partial response in 23/32 (72%) and complete response in 1/32 (3%) treatments. In total, 30 pre-TKI PET/CTs (24 ⁶⁸Ga-DOTATATE PET/CTs, 6 ¹⁸F-FDG PET/CTs) were performed. Pre-TKI ⁶⁸Ga-DOTATATE PET/CTs did not correlate with TKI treatment response. In the ¹⁸F-FDG cohort, high MTV and TLA correlated with a better structural response (p < 0.001) and high SUVmean correlated with a longer time to reach optimal response (p = 0.037).

Conclusions: In a small cohort of MTC patients, MTV and TLA on ¹⁸F-FDG PET/CT were associated with the structural response of TKI treatment, suggesting their potential utility in identifying patients who are likely to respond significantly. In contrast, TKI response showed no correlation with uptake on ⁶⁸Ga-DOTATATE PET/CT.

Background: Papillary thyroid carcinoma (PTC) comprises the vast majority of all thyroid cancers. Lymph node metastases may be present even when the primary tumor is small and intrathyroidal. Metastatic lymph nodes of PTC presenting as giant solitary cervical cysts with no evidence of primary tumors in the thyroid gland even by postoperative pathological examination are rare.

Case presentation: A 33-year-old Chinese woman presented to the hospital with an incidental mass in her right neck. Ultrasonography and magnetic resonance imaging revealed a giant right cystic mass in the inferior submandibular gland. The patient underwent mass dissection. Histopathological assessment indicated metastatic papillary carcinoma from the thyroid. Total thyroidectomy and bilateral selective neck dissection were performed. Meticulous pathological examination revealed no lesions in the thyroid. After 18 months of follow-up, no signs of recurrence were noted.

Conclusion: It is difficult and challenging to differentially diagnose between ectopic PTC and lymph node metastasis from PTC. Meticulous pathological evaluation of surgical specimens is key to making a definitive diagnosis.

Objective: Graves' disease (GD) patients treated with radioactive iodine may face health risks from potential radiation exposure, both for themselves and their offspring. This systematic review aims to comprehensively evaluate the association between prior radioactive iodine (RAI) therapy for GD and subsequent pregnancy outcomes in women of childbearing age.

Methods: A search of the bibliographic databases PubMed/MEDLINE and Web of Science was conducted up to December 2024 to identify relevant studies.

Results: The final systematic review included 1055 patients from 5 articles, all of which were retrospective cohort studies. Two studies reported the incidence of miscarriage after RAI treatment of 2.3% (3/130) and 22.2% (6/27). One study indicated that the miscarriage rate in the RAI group was not significantly different from that in the control groups, while the other did not provide a statistical comparison between groups. Two studies reported the incidence of neonatal hyperthyroidism (NH) after RAI therapy of 11.3% (5/44) and 5.5% (8/145). Both studies indicated that high levels of serum TRAb during late pregnancy were significantly associated with NH (P < 0.05). One study reported the incidence of postpartum thyrotoxicosis (PT) after RAI therapy of 2.1%. Compared with surgical treatment and ATD treatment, patients with RAI therapy had a significantly lower incidence of PT (P < 0.05).

Conclusion: Based on the limited evidence from retrospective studies, current data does not demonstrate a statistically significant increase in the risk of miscarriage or postpartum thyrotoxicosis following RAI therapy, compared to ATDs or surgical treatment. Elevated maternal TRAb levels in late pregnancy were strongly associated with neonatal hyperthyroidism. However, the small sample sizes and heterogeneity in study designs preclude definitive conclusions. Further prospective studies are required to establish more comprehensive and reliable conclusions and to evaluate more pregnancy outcomes.

Background: The incidence of thyroid dysfunction is high in HIV patients, contributing to the high mortality and morbidity associated with HIV.

Objectives: This study focused on evaluating the prevalence of thyroid dysfunction and associated factors among people living with HIV (PLWH) attending Comprehensive care centre at Maua Methodist Hospital, Kenya.

Methods: Clinical and sociodemographic data of participants were collected including HIV viral loads, CD4 counts, HAART regimen and type, age, gender, marital and education status, and co-infection. Serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) were assessed in all groups. Regression analysis and Pearson correlation were performed to assess thyroid dysfunction and associated factors.

Results: The prevalence of thyroid dysfunction was 51.9% (95% CI: 50.8 ~ 53.2) in this population. 77% (77%) of the HAART group had thyroid dysfunction compared to 47% of the HAART naïve group. Additionally, the prevalence of thyroid dysfunction was high in the HIV-non-suppressed individuals (97%, 95% CI: 97.1 ~ 97.9) compared to suppressed group (83%, 95% CI: 82.7 ~ 84.3). HIV (p < 0.001), HAART exposure (p < 0.001), TB (p < 0.001) and duration of infection (p = 0.002) were significantly associated with thyroid dysfunction. There was a positive correlation between TSH (r = 0.28; p < 0.01) and HIV + individuals under HAART, TSH (r = 0.37; p < 0.001) and TB, and FT3 (r = 0.35; p < 0.001) and duration of infection. Additionally, there was positive corelation between thyroid dysfunction and age (r = 0.13, p = 0.13), and a negative correlation between thyroid dysfunction and CD4 counts (r = -0.39, p < 0.055) though statistically not significant.

Conclusions: Thyroid dysfunction is more common in HIV patients on HAART, mainly manifested as subclinical hypothyroidism. Routine screening for thyroid dysfunction should be considered for PLWH, especially those on HAART and with viral blips.

Background: Transforming growth factor-β (TGF-β) plays well-established roles in cancer cell invasion and epithelial-mesenchymal transition (EMT); however, its role in thyroid carcinoma (TC) remains unclear. This study aimed to evaluate the effects of TGF-β on EMT in TC and determine its underlying mechanisms.

Methods: Treatment of TC cell lines with TGF-β the morphology of thyroid cancer cells changed, Immunofluorescence staining revealed that the localization of E-cadherin shifted from the cell membrane to the cytoplasm, and the fluorescence intensity decreases. Wound-healing assay in BCPAP and TPC-1 revealed that migration ability was significantly higher in the TGF-β (5 ng/mL) treatment group than in the control group (P < 0.01).

Results: Transwell assays showed that the invasive abilities of TGF-β-treated BCPAP, TPC-1, and K1 cells were 7-, 10-, and 6-fold higher than those of the control group, respectively (P < 0.05). After TGF-β treatment, mRNA levels of SNAI1 significantly increased in TPC-1 and BCPAP cell lines. Treatment of TC cell lines with TGF-β downregulated the epithelial marker E-cadherin and upregulated the mesenchymal markers N-cadherin and vimentin, at the mRNA level. Western blotting indicated similar results at the protein level, TSH could enhance this process.

Conclusions: TGF-β promotes EMT-like phenotypic changes in thyroid cancer cells, accompanied by upregulation of SNAI1 and EMT-related markers, which is enhanced by TSH. Overall, this study provides a basis for the development of therapeutic strategies for TC targeting the EMT.

Micronutrients play a crucial role in several metabolic processes including thyroid hormone metabolism and functions. The current study aimed to assess the associations between thyroid hormone levels and micronutrient status in a cohort of adolescents Afghan refugees residing in a refugee camp in Pakistan. A randomised, community based, cross-sectional study design was employed to recruit 206 adolescent (both male and female) Afghan refugees aged 10-19 years. Sociodemographic data, anthropometric assessments and blood samples were collected using standard methods. Serum vitamins, minerals and thyroid hormones levels were assessed using ELISA, electrochemiluminescence and inductively coupled plasma mass spectrometry (ICP-MS) respectively. Overall results showed the median levels of T3 and TSH were significantly higher (p < 0.05) in younger adolescents (10-14 years) compared to 15-18 year olds while T4 was significantly higher in boys compared to girls. Correlational analysis between serum micronutrients status (vitamin D, vitamin B12, ferritin, folate, zinc, copper, selenium) and thyroid hormones revealed significant relationships in different age groups. Overall, vitamin D exhibited a statistically significant positive correlation with T4 (r = 0.279) in the combined, younger (r = 0.277) and older (r = 0.319) age groups. In contrast, a statistically significant but negative correlation was observed when zinc levels were compared with T3 (r=-0.288) in the older age group and with T4 (r=-0.195) in the younger age group. In conclusion, micronutrients status, especially vitamin D and zinc, have important implications for thyroid health and thereby require close monitoring in any thyroid deficiency related disorders in vulnerable population such as refugees.Clinical trial number: Not applicable.

Appropriate management of thyroid dysfunction in pregnancy is challenging in both its primary, secondary and tertiary forms of the disease. Primary hypothyroidism is by far most prevalent globally. Main causes are insufficiency of iodide supplementation in developing countries and autoimmunity in developed countries. However, after a very successful global implementation by World Health Organisation over decades accompanied by specific recommendations for management of the iodide supplementation during pregnancy, recent studies found that women both in USA and EU are again mild to moderately iodide deficient during pregnancy or going through assisted fertility treatment. This poses a disturbing risk in relation to foetal neurological and brain development. The diagnosis and treatment monitoring of the thyroid function during pregnancy are very challenged due to the extensive physiological as well as pathophysiological adaptations of the thyroid axis hormones to encompass a sufficient foetal supply. This is distorting the hormone measurements, since the normal limits are exceeded, and current biochemical methods are not calibrated for the adapted concentrations. Even though clinical guidelines exist there are still gaps in the evidence-based recommendations to guide clinicians to thyroid function management during pregnancy. Debut of hypothyroidism during pregnancy requires immediate diagnosis as it can lead to poor foetal outcome with intrauterine growth restriction and foetal demise on top of the risk for the neurocognition. Hypothyroidism in stable replacement treatment needs careful monitoring during pregnancy to adapt to the physiological changes in the requirement of the thyroid hormone thyroxine, and combination therapy with triiodothyronine is contraindicated. The frequent use of assisted reproduction technology (ART) with controlled ovarian hyperstimulation in these patient groups having disease induced low fertility has created an unrecognised risk of under-replacement due to accelerated oestrogen stimulation with increased risk of severe complications for both the woman and foetus. Longitudinal studies of the thyroid function bridging pre-ART, through ART to pregnancy and postpartum in different clinical settings are recommended. The area needs consensus recommendations between gynaecologists and endocrinologists in specialised centres to alleviate such increased gestational risk. There is a strong need of more research on improvement of thyroid hormone replacement, and biomarkers for treatment optimisation in this field of non-communicable diseases, which suffers from both limited attention from the health authorities and poor funding.